MSK and Rashes Flashcards
What are the features of ECZEMA in children?
Presents ~6months. 50% will clear by 5y and 75% at 10y.
Affects trunk and face, with extensor surfaces in younger children.
Management:
Avoid irritants, use simple emollients and topical steroids. Cream soaks in faster ~ use pump dispensers. Severe cases = wet wraps and oral ciclosporin may be used
What are the features of HAND, FOOT and MOUTH DISEASE?
- Mild systemic upset: Sore throat, fever etc.
- Then oral ulcers
- Followed by vesicles on palms/soles of feet
Most commonly caused by intestinal viruses (Coxsackie A16, Enterovirus 7H). Contagious and can cause outbreaks in nursery
Management: Symptomatic treatment and assurance. Children do NOT need to be excluded from school
What is TRANSIENT SYNOVITIS?
aka ‘Irritable Hip’
Generally presents as an ACUTE hip pain, associated with a viral infection
Typical age: 2 - 10y.
May also have low grade fever (high grade = SEPTIC ARTHRITIS)
Commonest cause of hip pain in children.
A self-limiting condition
What are the features of GROWING PAINS?
Pain in legs with no obvious cause or any other worrying features:
- Never presents in the morning after child has woken up
- No limp/limitation of activities
- Systemically well
- Normal physical examination
- Motor milestones normal
- Intermittent symptoms + worse after a day of vigorous activity
What are the features of CHICKEN POX?
A highly infectious virus (Varicella Zester) spread via the respiratory route. Incubation period: 10-21 days
Infectivity: 4 days before rash - 5 days after rash first appeared
Features:
- Fever initially
- Itchy rash from head/trunk then spread to rest of body
- First macular then papular, then vesicular
Supportive management: Keep cool, trim nails, calamine nails
Exclude school until all lesions are dry + have crusted over.
For immunocompromised: VZIG Vaccine/ IV Aciclovir
Complications: Secondary bacterial infections (NSAIDs and increased risk), Necrotising fascialitis, pneumonia, encephalitis, arthritis, nephritis, pancreatitis, disseminated haemorrhagic chickenpox
What are the features of SCARLET FEVER?
A reaction to erythrogenic toxins produced by Group A Haemolytic Streptococci (Typically Streptococcus pyogenes). Ages 2-6, with peak at 4y.
Features:
- Fever: lasts 24-48h
- Malaise, headache, nausea/vomiting
- Sore throat
- Strawberry tongue
- Rash (fine punctate erythema first on torso and spares palms and soles. Also a rough ‘sandpaper’ texture’. Desquamation occurs later in the illness
What is the management of SCARLET FEVER?
- Oral penicillin V for 10 days (Azithromycin for allergies)
- Children return to school 24h after commencing Abx
- Notifiable disease
Can be complicated by:
- Otitis media
- Rheumatic fever (typically occurs 20days after infection)
- Acute glomerulonephritis (typically 10days after infection)
- Invasive complications (meningitis, necrotizing fasciitis)
What are the features of PERTHE’S DISEASE?
A degenerative condition affecting the hip joints, typically ages 4-8y.
Caused by avascular necrosis of the femoral head (bone growing faster than blood vessels)
Features:
- Progressive hip pain
- Limp
- Stiffness and reduced range of movement
- Widening of joint spaces in XRay
Staged with the Catterall staging system
What is the management of PERTHE’S DISEASE?
Diagnosed via plain X-Ray, or MRI if X-Ray and symptoms persist
Management:
- If <6y, observation as good prognosis
- Older: Surgical management with moderate results
- Keep the femoral head within the acetabulum with cast/braces
- Operate on severe deformities
Most cases will resolve with conservative management - early diagnosis improves outcomes. Potential complications include osteoarthritis or premature fusion of the growth plates
What are the features of KAWASAKI DISEASE?
A type of vasculitis. Clinical diagnosis of:
- High grade fever >5days resistant to antipyretics
- Conjunctival infection
- Bright red, cracked lips
- Strawberry tongue
- Cervical lymphadenopathy
- Red palms/soles which later peel
What is the management for KAWASAKI DISEASE?
- High-dose aspirin
- Intravenous immunoglobulin
- ECHO (rather than angiography) to screen for coronary artery aneurysm as a potential complication
What are the features of SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)?
Typically occurs around 10-15y, more common in obese children and boys. Displaces the femoral head epiphysis postero-inferiorly
Features:
- Hip, groin, medial thigh or knee pain
- Loss of internal rotation of the leg in flexion
- Bilateral slip in 20% of cases
Diagnosed by AP and lateral (typicalyl frog-leg) XRay views and managed by internal fixation
What are the risk factors of DEVELOPMENTAL DYSPLASIA OF THE HIP?
Risk Factors:
- Female sex
- Breech presentation
- Positive family Hx
- Firstborn
- Oligohydramnios
- Birth weight >5kg
- Congenital calcaneovalgus foot deformity
Slightly more common in left hip
What are the clinical examination findings for DEVELOPMENTAL DYSPLASIA OF THE HIP?
- Barlow test
- Ortolani test
- Symmetry of leg length
- Levels of knees when hips and knees are bilaterally flexed
- Restricted abduction of the hip in flexion
Also use ultrasound to confirm diagnosis
What is the management for DEVELOPMENTAL DYSPLASIA OF THE HIP?
- Most will spontaneously stabilise by 3-6weeks of age
- Pavlik harness in children younger than 4-5 months
- Older children may require surgery
